Introduction

Today we are going to discuss what The Lancet thinks is wrong with healthcare in the United States, how this compares to other evaluations, its costs in both lives and dollars and how to completely fix this system.

The Problem

The Lancet, a science based journal in the UK, published an article on January 4, 2025, titled “Whispers from the Imperial Capital” that stated

“The assassination of Brian Thompson, UnitedHealthcare's Chief Executive Officer, on Dec 4, 2024, in New York City, has catapulted American medicine, with all of its tragic inconsistencies and injustices, once again into the political spotlight. With the words “deny”, “depose”, and “defend” inscribed on three bullet casings, attention was drawn to the questionable practices of America's health insurance companies. They faced allegations of delaying payments, denying settlements, and defending obstructive behaviours by tying patients up in expensive litigation. It was—and is—quite a charge sheet for US President Donald Trump to address after his inauguration later this month. The murder of Thompson coincided with the launch in Washington, DC, in collaboration with the Council on Foreign Relations, of The Lancet's Presidential Briefing Book on the state of America's health. Led by the Institute for Health Metrics and Evaluation, new research described wide disparities in wellbeing across race and ethnicity, age, sex, and location; extraordinary inequalities in life expectancy; a huge burden of diseases, injuries, and risk factors; worsening prevalence of overweight and obesity among children, young people, and adults; and “the alarming trajectory of health challenges in the USA”, based on forecasts to 2050. But these findings are surely far more than alarming. They demonstrate the utter failure of America's health system to reap benefits from the vast resources the country spends on health care and medical research. A reset is urgently needed.”

Let’s break this down and see what we need to solve these problems.

Analysis

Our analysis suggests that The Lancet identified six problems:

Delaying payments
Denying settlements
Delaying through litigation
Wide disparities in wellbeing
Inequalities in life expectancy
Obesity

We find two different categories of problem here. First, delaying and denying payments. Second is chronic disease. Let's take a closer look at each.

Denying and Delaying Payments

Denying and delaying payments are business tactics designed to increase profits for health insurance companies. By denying payments the insurance company gets to simply keep premiums collected instead of paying them back as benefits. Delaying payments, either through denials or litigation keeps the coffers full and earning interest for the company, much the same way Zelle or PayPal earns their profits. All of this is illegal and unethical and is costing lives, that is, literally killing people.

Your health insurance company returns, on average, 53% of your premium as benefits. Yes, that means that they waste 47% of your premium, doing whatever it is that they do that isn’t ‘write a check to pay your doctor.’ On the surface, that seems very simple, but apparently coming up with these delaying and denying tactics is a lot of expensive work that you are paying for.

Chronic Disease

Treatment for chronic, behavior based disease consumes 84%, or $3.7 trillion, of the $4.4 trillion spent on healthcare each year in the US. If we could get back even a portion of the $3.7 trillion, we could lower the overall cost of healthcare and save millions of lives.

Analysis Conclusion

It seems that the problems identified by the Lancet distill down into two things: money and education. If we can pry this industry out of the greedy fingers of the finance people, we can reduce costs. If we can figure out a way to incentivize patients to live a healthier lifestyle, we can further reduce costs and save millions more lives.

The Solution

The solution is to put health insurance companies out of business. You don’t want bankers running anything; they crash the economy every ten years on average, and it doesn’t have to be that way. Yes, bankers are running insurance companies. Just like The Lancet, The Commonwealth Fund, identified several problems in their paper “U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes” That basically boiled down to the same two problems:

Health insurance is too expensive
Patient education is largely ignored

These sound amazingly like the two categories from The Lancet: money and education. If we can address these two problems, we can fix the US healthcare system.

The Concept

Health insurance companies have two inputs: a patient and a procedure, and one output: a check to the practice for the procedure performed. That is it. If we automate the process between the input and the output, then we have eliminated everything the insurance company does, except for transferring the money. The only other thing we need to add would be some way to educate and incentivize the patient on how to live a healthy lifestyle. That would result in fewer claims, causing reduced rates for everyone.

The Execution

We at Sentia have designed and developed a solution that completely automates health insurance. We provide the Electronic Medical Records (EMR) system to the practice, and when they code a patient encounter, we pull out the procedures performed and pay for them in real time. There is no adjudication, no denials, no medical coding, no big buildings, no people and most importantly, little to no cost once the system is built. For this service we charge $10 per month plus the actual cost of the risk. Remember that your health insurance company only returns 53% of your premiums as benefits. We can return the 47% they waste, on average to the patient, in lieu of the previously stated $10 per month. There are other efficiencies we will explain, and a way to manage chronic, behavior-based disease.

Patient Education

Also remember that treatment for chronic, behavior based disease consumes 84%, or $3.7 trillion, of the $4.4 trillion spent on healthcare each year in the US. The average of avoidable deaths per 100,000 in OECD countries is 225. In the US it is 335, or about 33% higher. If we could bring the US average down to the OECD average, we would save about $1.2 trillion. That is a further reduction in costs of about a quarter of the total.

How do we do this? We offer financial incentives for people who live a healthier lifestyle as measured by our built-in health and wellness system. This system takes into account measurements taken at the primary care physician’s practice, like height, weight and blood pressure, plus things screened for in blood work. Additionally, there is a mental health screening right in the wellness package. This system looks at all these factors and then prescribes patient education based on the results. At Sentia, this is part of the system. We can tell when the patient opened the patient education and how long they spent reading it, and offer a small discount for simply doing so. A larger discount is offered for reading and following the education, as evidenced by better results in the patient screening.

The Finances

Let’s look at big round numbers. Let’s say we can save the patient about 40% on their health insurance up front. Let’s say that we save the people of the US another 25% by being educated about healthy living and getting to the average OECD deaths per 100,000. We know that eliminating medical coding, providing a free EMR to the practice and putting compliance and efficacy reporting into that system will save each and every practitioner an additional $77,000 per year that they currently spend. That however is only about 2% of the total, so we’ll just ignore it. If we total all that up, we see more than 60% savings. That means that we would have not only the best healthcare on the planet but also the cheapest.

Conclusion

The way that health insurance is run is a complete scam. We have shown a way to save about 60% from the cost of health insurance and addressed both of Commonwealth Fund’s two conclusions about health insurance in the US: cost and education. We have all of this written and deployed in a prototype application. The only thing we really need to get this all started is to clean up that application and turn it into an enterprise application with logging, administration and redundancies in hardware. We will need funding, probably about $100 million over the first two years, like other startup health insurance companies. For comparison, United Healthcare had revenue of $371.6 billion and net earnings of $22.3 billion. With a ~60% savings we should service and retain 90% or more of the 300 million insured people in the US. That gives us a revenue of $36 billion, however, everything in our system is automated so that is a $32.4 billion profit at a 90% profit margin.

If you want to be a part of saving healthcare and make a ton of money, here is your opportunity.

We have shown a way to make patients healthier by educating them on the consequences of their behavior, and a way to capitalize on that to the sum of $1.2 trillion or about 25%. If we add that to the process automation savings of our solution, we are in the ballpark of more than 60% savings in total. We already have the best doctors and the best equipment; we just need to implement the above detailed framework to give them all the tools necessary for success.

We have this system in prototype now, fully functioning.

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We have built a comprehensive health information system to keep the patient healthy and on the right track with the ability to incentivize healthy living. Implementing this system should be fairly simple and will completely revolutionize the way healthcare is paid for, saving countless lives. We have shown a way to use this system to make the best healthcare system in the world also the most efficacious and the most affordable, and a way to move toward value-based care.

The Lancet states “ …the utter failure of America&#39;s health system” is eminent

1/6/2025 12:00 AM